Radical Cystectomy Compared to Combined Modality Treatment for Muscle-Invasive Bladder Cancer : A Systematic Review and Meta-Analysis of over 12,000 patients
A partir d'une revue systématique de la littérature publiée jusqu'en mars 2016 (19 études incluant 12 380 patients au total), cette méta-analyse compare l'efficacité, du point de vue de la survie sans progression, de la survie spécifique et de la survie globale à 5 et 10 ans, et les complications d'une cystectomie radicale et d'un traitement multimodal (comportant une radiothérapie, une chimiothérapie concomitante et une résection transurétrale maximale de la tumeur) chez les patients atteints d'un cancer invasif de la vessie
Purpose : Radical cystectomy (RC) has been the mainstay treatment for muscle-invasive bladder cancer (MIBC) while combined modality treatment (CMT-radiation therapy, concurrent chemotherapy and maximal transurethral resection of bladder tumor) is preserved for patients with substantial comorbidities. We performed a comprehensive assessment of overall survival (OS), disease-specific survival (DSS), progression-free survival (PFS), and treatment-related complications between RC and CMT. Methods : We searched seven databases (PubMed, Scopus, EMBASE, Proquest, CINAHL, and the clinical trials.gov) for randomized-controlled trials (RCTs) and prospective and retrospective studies directly comparing RC with CMT from database inception to March 2016. We conducted meta-analyses evaluating OS, DSS, and PFS with hazard ratios (HR) and 95% confidence intervals (CI). Results : Nineteen studies evaluating 12,380 subjects were selected. For the 8 studies encompassing 9554 subjects eligible for meta-analyses, we found no difference in OS at 5 years (HR: 0.96, favoring CMT, CI [0.72–1.29; p = 0.778]) or 10 years (HR: 1.02, favoring cystectomy, CI [0.73–1.42; p = 0.905]). No difference was observed in DSS at 5 years (HR: 0.83, favoring radiation, CI [0.54–1.28; p = 0.390]) or 10 years (HR: 1.17, favoring cystectomy, CI [0.89–1.55; p = 0.264]), or PFS at 10 years (HR: 0.85, favoring CMT, CI [0.43–1.67; p = 0.639]). The cystectomy arms had higher rates of early major complications while rates of minor complications were similar between the two treatments. Conclusion : Current meta-analysis reveals no differences in OS, DSS, or PFS between RC and CMT. Further RCTs are necessary to identify the optimal treatment for specific patients.